CLAIM #__
1
AFFIDAVIT OF HEIRSHIP
Complete this form if you believe you are the heir to property held by the Nevada
Unclaimed Property Division. Do not complete this form if the decedent’s estate went
through probate in court, if there has been some other type of court determination OR
if you are the surviving spouse.
1. Please complete all fields:
Decedent’s Name: Date of Death:
Your Name: Your Relationship to Decedent:
Was Decedent Married at Time of Death? Yes / No
Decedent’s Spouse at Time of Death:
Spouse’s Date of Death (If Applicable):
2. Provide information on all of the decedent’s natural born and adopted children only, both living and deceased:
(If none, please write “none” - This section cannot be blank)
Child’s Name Birth Date Date of
Death (If
If Deceased, Does Deceased
Child have Children (Circle
One)
3. Provide information on the decedent’s grandchildren, born only to the deceased children indicated in section 2
(If none, please write “none”)
Grandchild’s Name Birth Date Name of Deceased Parent